3. Diagnostic methods

Besides our own eyes and hands, there are some other special diagnostic tests we can use in order to finally determine the exact problem. One of the most common and routinely performed tests are simple plain hand X-rays. As we know, the hand is a complex structure where many anatomic elements interact with each other. It is not just skin and subcutaneous tissue; we have bones, ligaments, tendons, nerves, arteries, veins, muscles, and joints that when acting together the hand will achieve a normal and complete function. There are some other special tests that can be asked in some special situations, like CT scans, MRI, electromyography, nerve conduction studies, Doppler ultrasound, and so on. As we have said the diagnosis must be made by us, not be expected to pop out spontaneously by some random and unnecessary studies.

plan. Other important questions are as follows: What type of anesthesia will you use? Will you use local anesthesia? What nerves will you anesthetize? What is the type and duration of ischemia of the hand? Will you have pauses between periods of ischemia? At what pressure will the tourniquet be inflated? Is a microscope needed for the procedure? Is there any special equipment or instruments you may need? Do you need microsurgical instruments? Do you need equipment for bony fixation? Do you have your surgical loupes or some kind of magnification? Will you need X-rays to be taken after bony fixation? Is every suture you are going to need ready? What type of cast or immobilization will you use after the procedure? These questions ideally must be answered during your planning as if it was a checklist so it will be easier for you to make sure everything is ready before the surgery takes place

Figure 1. Use of microscope, microsurgical instruments, hand table and controlled ischemia of the hand during surgery.

Introductory Chapter: The Art of Hand Surgery http://dx.doi.org/10.5772/intechopen.76668 5

Once you have completed your surgery, you have to decide if your patient may need a special rehabilitation program so he or she can get the best functional result possible. For some procedures, it would just be enough with some exercises the patient can perform at home. For some others, you may need special casts or immobilization, followed by specialized hand therapy. It is important to discuss these questions with the patient before the procedure takes place. As I usually say to my patients, the results depend 50% in the surgery itself, and the other 50% will depend on the patient itself and on the hand therapist. This specialized work is not just a one-day job. It is mandatory that the hand surgeon reevaluates his patient as many

times as needed until his or her function has been completely reestablished.

(Figure 1).

6. Post-operatory care
